Life expectancy for Russian men — 59 years — remains astonishingly low, and well below current levels in Pakistan and Bangladesh. That has combined with anemic fertility levels to cause a drop in population. According to United Nations predictions, Russia's population could fall by 30 percent by the middle of the century.

President Dmitry Medvedev is determined to reverse the trend. His government offers birth bonuses of $9,500 — and the government is investing more into public health.

Gains Made In Chelyabinsk

Chelyabinsk is in the middle of a baby boom — a result of recent economic improvements. Dr. Eduard Reebin, chairman of the Regional Legislatures Medical Commission, says care is much better than it was 10 years ago.

"There's no comparison," Reebin says. "Of course, we still don't have what we want — no country does — but under Putin, there is a stable health program."

Reebin recalls desperate times 10 years ago when he had to barter and scrounge for basic medicines.

"The factories could not pay their share of the health insurance, so they would give me pipes," he says. "I would go to another region and trade them for rice, bring the rice back here, and sell it just to keep the hospital open."

Those frightening times are over. But the system is still short of specialists, and diagnostic tools like CT scans and MRI are still rare. The wait for an MRI scan can be more than two months.

Remaining Deficiencies

After a meeting with regional officials, the head of Hospital No. 8 rants about a tangled and unresponsive medical bureaucracy. Dr. Mikhail Verbitksy is a generally jovial fellow, but he is struggling to pay his staff a decent wage so they will stay in the profession.

He has to skimp on physical improvements to pay his staff a little extra, but the hospital — built 60 years ago — is in terrible shape. There are no proper hospital beds or call buttons. There's a shortage of operating rooms. The hospital is overcrowded, with twice as many patients as originally planned for.

The number of babies born there annually has jumped in the past year from 1,200 to 2,000 — good news for Russia, but a real strain on the hospital.

Tanya Kelleher, who gave birth to twins, says her doctors were well-trained, but the overall conditions were appalling.

"Horrible, horrible," Kelleher says. "A room with 10 women in it. You have to go to a pharmacy and buy everything — stitching, cotton wool. Everything you need during the birth, you buy and pay for. We were told to bring our own sugar. If you are a patient in a hospital, you better have a friend who can bring you food."

In theory, medical care is free, but medicines are not — except for certain groups like invalids and pensioners. Repeated complaints in the media indicate that these groups are not getting the medicines they need and have been promised. Dr. Reebin acknowledges that this is an ongoing problem.

"No one will be turned away, but there will always be medicines which are not available at the hospital, and the patient will have to purchase them at a pharmacy," he says.

Clinics Struggle To Fill The Gap

What has dramatically changed in the past 10 years is the development of private clinics like Elena Konaeva's reproductive health center. A much-respected doctor, Konaeva specializes in infertility and now has 3,000 patients.

"We have good doctors in Chelyabinsk," Konaeva says, "but they are spread out over various hospitals. You can get a good diagnosis at one hospital, good surgery at another. We try to link all that together and make it more comfortable."

Given the system of under-the-table payments in state hospitals for expedited care and the provision of certain treatment, care from these clinics is not that much more expensive than so-called "free" care.

"Take in vitro [fertilization]," Konaeva says. "You usually have to pay for this even in the state system. Until this year, there was no state hospital here in Chelyabinsk that could do in vitro, and state doctors here still have little experience. We work with a hospital in another city if patients need this treatment. It's the best in Russia."

Konaeva's clinic — spotlessly clean with a rare air of efficiency — is comparable to any Western doctor's office. Many of her physicians, like urologist Grigory Bogdashov, are specialists in the state system who work here one day a week.

"At the state hospital, I earn $200 a month, $400 with overtime," Bogdashov says. "Here, I can make $200 in three hours of work, without the mess, the pressure and the horrible conditions."

Dr. Konaeva offers her patients preventive care, which she says the state system can no longer afford. Mammograms, for instance, are not routine and are done only when a problem arises. She sees too many underweight babies because of smoking, alcohol and inadequate prenatal care. She worries that too many Russian women still use abortion as a means of birth control. There are still more abortions than live births, with the consequent impact on fertility rates.

"It's a sad statistic," Konaeva says, "but a true one."

Five years ago, this clinic took an initial investment of $150,000 and had a vision. Dr. Konaeva has made back her investment. Her dream was realized. And behind her, lining the wall, are snapshots of Chelyabinsk's next generation — the babies she has helped bring into the world.